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Biomedical subjects

D B Redwine

Publications and source records attributed to D B Redwine.

At least 37 records · Page 2Linked to original sources
PubMed1994

Remote recollection of preoperative pain in patients undergoing excision of endometriosis.

To determine the accuracy of postoperative recall of preoperative pain, this prospective, longitudinal study was conducted by a general gynecologist in private practice at a referral center. Before excision of endometriosis at laparoscopy or laparotomy and again at 6 to 18 months after surgery, 168 patients completed a 5-point scale assessing 11 symptoms that may be related to endometriosis. For 6 of the 11 symptoms, over 50% of patients had exact recall of pain level. For 10 symptoms, over 80% recalled their preoperative pain level within +/-1 point. Patients requiring reoperation were most likely to recall preoperative pain levels accurately. Those not requiring reoperation tended to inflate slightly their remote assessment of preoperative pain, indicating that successfully treated patients tend to forget how much they formerly hurt.

Endometriosis↗
PubMed1994

Endometriosis persisting after castration: clinical characteristics and results of surgical management.

OBJECTIVE: To identify the clinical characteristics and response to surgical treatment of endometriosis-associated pain in castrated women. METHODS: In a prospective, longitudinal observational study, 75 patients with previous castration had biopsy-proven endometriosis excised surgically. Anatomical characteristics of disease were studied using pelvic mapping and compared to the findings in non-castrated women with endometriosis. Preoperative and postoperative verbal analogue pain scales were used to gauge the response to excision of endometriosis. RESULTS: Patients treated surgically for endometriosis following castration were significantly older (37.8 +/- 8.1 versus 31.3 +/- 6.9 years, mean +/- standard deviation; 95% confidence interval [CI] 4.9-8.1) and slightly more likely to have intestinal involvement (risk ratio 1.3, 95% CI 0.94-1.8) than non-castrated endometriosis patients. Most had marked alleviation of pain after excision of endometriosis. CONCLUSIONS: Endometriosis can remain symptomatic after castration, with or without estrogen therapy. In such patients, there is a 33% frequency of intestinal involvement. At castration, consideration should be given to removal of invasive peritoneal and intestinal disease. Symptom improvement occurs in most patients after excision of endometriosis.

Adult↗
PubMed1993

Laparoscopic excision of endometriosis with 3-mm scissors: comparison of operating times between sharp excision and electro-excision.

To determine if laparoscopic excision of endometriosis by electrosurgery is more rapid than by sharp dissection, a retrospective comparative study was made of operative times for the two procedures. Median operating times for laparoscopic electro-excision of endometriosis were 26% to 49% faster than excision by sharp dissection. A chi2 analysis of the frequency counts of surgical intervals, and disease stage revealed this difference to be statistically significant and not due to acquired experience or differences in extent of disease in the two groups. The reduction in operating time achieved with monopolar electro-excision seems primarily associated with a more rapid cutting action with simultaneous coagulation of bleeders.

Dissection↗
PubMed1992

Laparoscopic segmental resection of the sigmoid and rectosigmoid colon for endometriosis.

Patients with symptomatic endometriosis of the colon and distal small bowel usually present with crampy abdominal pain, pelvic and rectal pain, constipation, and dyspareunia. Superficial disease can be easily resected laparoscopically with scissors. Deeper lesions require full-thickness resection and closure of the bowel. Occasionally deep, large, or multiple lesions will require segmental resection for adequate control of the disease. Five patients with intestinal endometriosis underwent attempted laparoscopic segmental colon resection. Two patients required conversion to open laparotomy because of difficulty with the anastomosis. No operative complications or deaths occurred in this group. Those patients undergoing laparoscopic colectomy showed return of bowel function within 24 to 48 h and were discharged home on postoperative day 4.

Adult↗
PubMed1991

Conservative laparoscopic excision of endometriosis by sharp dissection: life table analysis of reoperation and persistent or recurrent disease.

OBJECTIVE: To determine the long-term outcome after laparoscopic excision of endometriosis. DESIGN: This longitudinal unmatched study evaluated surgical outcome using follow-up questionnaires and evaluation of reoperations with results presented in life table format. SETTING: Surgery was performed by a private practitioner at a referral center. PATIENTS: All 359 patients undergoing laparoscopic excision of endometriosis between December 12, 1980, and March 31, 1990, were studied. INTERVENTIONS: Endometriosis, including deeply invasive disease, was completely excised laparoscopically using 3-mm scissors and graspers. Adjunctive medical therapy was not used. MAIN OUTCOME MEASURES: Extent of disease present at reoperation and quarterly rates of reoperation and recurrent/persistent disease are used as indicators of efficacy of surgery. RESULTS: Interval rates of reoperation and recurrence/persistence of disease and extent or invasiveness of disease when found at reoperation did not increase with the passage of time after surgery. The maximum cumulative rate of recurrent or persistent disease was 19%, achieved in the 5th postoperative year. CONCLUSION: Laparoscopic excision of endometriosis results in a low rate of minimal persistent/recurrent disease. The natural history of endometriosis after surgery suggests a rather static nature of the disease.

Endometriosis↗
PubMed1991

Laparoscopic segmental resection of the sigmoid colon for endometriosis.

We report a technique for laparoscopic segmental resection of the sigmoid colon. A 30.73-year-old nulligravida complained of pelvic pain, abdominal bloating, intestinal cramping, and painful bowel movements. Examination revealed significant nodularity of the posterior pelvis, so a preoperative bowel prep was given. At laparoscopy, a 5 cm diameter mid-sigmoid lesion was found, as well as a rectal nodule and pelvic endometriosis. The sigmoid lesion was separated from the mesocolon by bipolar electrocoagulation and scissors dissection. The segment was then removed by transection with a needle electrode and extraction through the anus. A stapled end to end anastomosis was performed. This technique can be applied to a variety of benign lesions of the bowel, and can result in decreased patient morbidity and hospital stay.

Adult↗
PubMed1990

A serial section study of visually normal pelvic peritoneum in patients with endometriosis.

Defined criteria were used to select small samples of visually normal study peritoneum for serial section light microscopy in 45 patients with biopsy-proven endometriosis and 10 patients without endometriosis. A glandular element compatible with possible endometriosis was found in only 1 patient. Visually normal peritoneum does not harbor a high prevalence of invisible microscopic endometriosis.

Biopsy↗
PubMed1990

Endometriosis of the obturator nerve. A case report.

A 33-year-old woman, para 1001, had pain in the inner right thigh and proximal right leg weakness. At surgery a locally invasive, fibrotic lesion was found encircling the right ureter, right internal iliac vein and obturator nerve. It extended to the periosteum of the ilium. The lesion was dissected successfully without damage to vital structures, and endometriosis was confirmed histologically.

Adult↗
PubMed1989

Peritoneal blood painting: an aid in the diagnosis of endometriosis.

Visual identification of endometriosis is important, identification of very subtle manifestations of disease has recently received increased attention. Colorless and other subtle manifestations of peritoneal disease can be seen more easily by painting the peritoneal surface with bloody peritoneal fluid.

Endometriosis↗